Which is required by the nurse prior to putting the bed or chair ...

[drink]

Which is required by the nurse prior to putting the bed or chair exit safety-monitoring device in place?
 
  1. Obtaining a health care provider's order
  2. Documenting the use of the alarm system
  3. Testing the alarm
  4. Applying the leg band or sensor pad

Question 2

The unlicensed assistive personnel (UAP) informs the nurse that the client has pulled the IV catheter out again and is not oriented to time or place. Which task could the nurse safely delegate to the UAP at this time?
 
  1. Applying wrist restraints
  2. Calling the health care provider to obtain an order for restraints
  3. Getting mitt restraints from the supply room and meeting the nurse in the client's room
  4. Applying some form of restraint to limit the client's ability to pull the IV line out again

[ansleighelindsey]

Answer to Question 1

Correct Answer: 3

Before applying the system, the nurse should test the alarm to ensure that it works and is set high enough to be heard. It is also wise to allow the client to hear the alarm so it does not frighten her when it goes off. After testing the alarm, the nurse would apply the leg band or sensor pad. There is no need for a health care provider's order, as this is an independent nursing action. Documentation would occur after application of the system.

Answer to Question 2

Correct Answer: 3

It is the nurse's responsibility to assess the client before making a decision to apply a restraint, so asking the UAP to apply a restraint prior to the nurse's assessment would not be safe. The nurse should determine what type of restraint to use, and should call the health care provider for an order. The UAP could obtain restraints anticipated to be needed by the nurse and meet the nurse in the room to help with applying them once the nurse has completed the assessment.